Sleep duration in the United States 2003-2016: first signs of success in the fight against sleep deficiency?

Negative health outcomes in long sleepers: The societal sleep restriction hypothesis

Society imposes work and school schedules, as well as social expectations, that militate against consistently obtaining more than 7-9 h of sleep every 24 h. For most but not all adults this sleep duration is adequate. But among those who consistently obtain more than 9 h of sleep per day ("long sleepers"), there likely exists a subpopulation of individuals who are nevertheless failing to obtain enough sleep to satisfy their physiological sleep needs - a consequence of "restricting" their daily sleep durations to whatever extent they can tolerate so as to conform as closely as possible to society's norms and expectations. It is hypothesized that the 'long sleep arm' of the seemingly paradoxical U-shaped relationship between sleep duration and negative health outcomes can be explained, at least in part, by the existence of a subpopulation of such 'sleep-restricted long sleepers.'

The dynamic responses of mood and sleep physiology to chronic sleep restriction and subsequent recovery sleep

Healthy sleep of sufficient duration preserves mood and disturbed sleep is a risk factor for a range of psychiatric disorders. As adults commonly experience chronic sleep restriction (SR), an enhanced understanding of the dynamic relationship between sleep and mood is needed, including whether susceptibility to SR-induced mood disturbance differs between sexes. To address these gaps, data from N = 221 healthy adults who completed one of the two multi-day laboratory studies with identical 9-day SR protocols were analyzed. Participants randomized to the SR (n = 205) condition underwent 5 nights of SR to 4 hours of time-in-bed and were then randomized to one of the seven sleep doses that ranged from 0 to 12 hours in 2 hours increments; participants randomized to the control (n = 16) condition received 10 hours time-in-bed on all study nights. The Profile of Mood States (POMS) was used to assess mood every 2 hours during wakefulness and markers of sleep homeostasis (EEG slow-wave activity (SWA)) were derived via polysomnography. Mood progressively deteriorated across SR with marked disturbances in somatic mood components. Altered sleep physiology contributed to mood disturbance whereby increased EEG SWA was associated with increased POMS Total Mood Disturbance scores, a finding specific to males. The mood was restored in a dose-response fashion where improvements were greater with longer sleep doses. These findings suggest that when lifestyle and environmental factors are inhibited in the laboratory, the affective consequences of chronic sleep loss are primarily somatic mood disturbances. Altered sleep homeostasis may contribute to mood disturbance, yet sleep-dependent mechanisms may be sex-specific.

Temporal Trends in Cardiovascular Health Status Among Chinese School-Aged Children From 1989 to 2018: Multiwave Cross-Sectional Analysis

BACKGROUND

Despite the release of updated metrics for Life's Essential 8 (LE8), key indicators for assessing cardiovascular health (CVH) status, there is currently no report on their distribution among Chinese children.

OBJECTIVE

This study aimed to assess the nationwide distribution of CVH in Chinese school-aged children using LE8 scores and analyze temporal changes in these scores over time.

METHODS

Participants aged 7 to 19 years from 11 waves (between 1989 and 2018) of the China Health and Nutrition Survey were included in this study. LE8 components were grouped into 2 domains of health behaviors (diet, physical activity, nicotine exposure, sleep) and health factors (BMI, blood lipids, blood glucose, blood pressure). Scores of overall CVH and each LE8 metric were calculated individually. Temporal changes were assessed with joint point regression models by rural and urban living residence. The causal relationships between health behaviors and health factors that changed the most over time were built with cross-lagged panel models.

RESULTS

A total of 21,921 participants, 52.6% (n=11,537) of whom were male, who had data for at least 4 CVH components were included in the analysis. The mean age was 13 (SD 3.6) years. The overall CVH score remained stable in most regions, with the lowest found in Shandong from East China, which had a mean between 67 (SD 10.9) and 67.2 (SD 12.4). In contrast, the highest score was found in Guizhou from Southwest China, with a mean between 71.4 (SD 10.8) and 74.3 (SD 10.3). In rural areas, the diet score decreased significantly from 1997 onward with a speed of 0.18 (95% CI: 0.15-0.21; P<.001) per year, and the BMI score decreased significantly from 2005 onward with a speed of 0.56 (95% CI 0.44-0.68; P<.001) per year. In urban areas, the diet score decreased from 1994 onward with a speed of 0.03 (95% CI: 0.001-0.07; P=.04) per year, and the BMI score decreased from 2002 onward with a speed of 0.63 (95% CI 0.47-0.79; P<.001) per year. The sleep score dropped constantly in both urban and rural areas, with a speed of 0.69 (95% CI 0.58-0.80; P<.001) and 0.69 (95% CI: 0.52-0.86; P<.001) per year, respectively. A decline in the diet score led to a decline in the BMI score with a coefficient of 0.190 (95% CI 0.030-0.351; P=.02), while a decline in the BMI score led to a decline in sleep health with a coefficient of 0.089 (95% CI 0.010-0.168; P=.03).

CONCLUSIONS

Chinese school-aged children and adolescents were generally of moderate CVH status, but mutual influences existed between CVH metrics. Dietary interventions should be prioritized for promoting overall CVH in the future.

Sleep quality and sleep-related issues in industrial workers: a global meta-analysis

Objectives. Sleep-related issues are important health issues. This study aimed to investigate the global prevalence of sleep-related issues in industrial workers. Methods. A syntax of keywords was used to search the PubMed, Web of Science and Scopus databases. The search time was limited to articles published until September 2020, and the search range was in English. Events and samples were extracted for each study to calculate the prevalence. For all subgroups, events and samples were extracted to calculate the results of the subgroups. The random-effects method was used in the analysis. Heterogeneity was examined at the levels of all analyses. Results. Forty-eight articles were included in the analysis as eligible studies. Sleep-related issues have 30% prevalence in the 95% confidence interval (CI) [25, 35%]. The prevalence of sleep-related issues in men was 38%, 95% CI [31, 45%] and in women was 32%, 95% CI [14, 50%]. The prevalence of poor sleep quality, insomnia, sleep duration <7 h, snoring and sleepiness was 36, 22, 37, 29 and 10%, respectively. Conclusions. Sleep-related issues have a high prevalence in industrial workers, and the cause of these differences needs to be addressed and increasing insights provided to prevent and treat sleep disorders.

Secular trends of sleep-wake patterns in Hong Kong preschoolers

OBJECTIVE

To evaluate the secular trends of sleep-wake patterns of Hong Kong preschool children.

METHODS

Kindergartens from the four geographical regions of Hong Kong were randomly invited to take part in a sleep survey in 2012 and again in 2018. The parent-completed questionnaire provided information on socioeconomic status (SES), children's, and parental sleep-wake patterns. Secular trends and risk factors associated with short sleep duration in preschoolers were explored.

RESULTS

A sample of 5048 preschool children was included in the secular comparison, with 2306 and 2742 from the 2012 and 2018 surveys, respectively. A higher percentage of children in 2018 (41.1% vs 26.7%, p < 0.001) did not achieve the recommended sleep duration. During the survey years, sleep duration decreased by 13 ([95%CI: 18.5 to -8.1]) and 18 min ([95%CI: 23.6 to -12.2]) on weekdays and weekends, respectively. The overall trend of nap decrease was not significant. Sleep onset latency significantly increased on both weekdays (6 min [95%CI: 3.5 to 8.5]) and weekends (7 min [95%CI: 4.7 to 9.9]). Children's sleep duration was positively correlated with parental sleep duration with a correlation coefficient ranging from 0.16 to 0.27 (p < 0.001).

CONCLUSIONS

A significant proportion of Hong Kong preschool children did not achieve the recommended amount of sleep. A downward secular trend in sleep duration was observed during the survey period. Public health measures to improve sleep duration in preschool children should be a high priority.

Trends in prevalence of short sleep duration and trouble sleeping among US adults, 2005-2018

STUDY OBJECTIVES

To determine trends in prevalence of short sleep duration and trouble sleeping among US adults from 2005 to 2018, and to assess how sleep trends vary by sex and race/ethnicity.

METHODS

Seven cycles of the National Health and Nutrition Examination Survey data between 2005-2006 and 2017-2018 were analyzed. Trouble sleeping and sleep duration were self reported. Short sleep duration was defined as sleep duration ≤6 hr. Age-standardized prevalence of reporting trouble sleeping to a health care provider and short sleep duration were estimated among the overall US adult population, and by sex and race/ethnicity.

RESULTS

From 2005 to 2014, the age-adjusted prevalence of short sleep duration remained similar in the overall population (p for trend >0.05). Non-Hispanic Black people had the highest prevalence of short sleep duration among all race/ethnicity groups in all seven cycles. The prevalence of short sleep duration appears lower in 2015-2018 than in 2005-2014 due to different measurement methods applied. However, from 2005 to 2018, there were increasing trends in age-adjusted prevalence of reporting trouble sleeping to a health care provider in the overall population, among both men and women, and all race/ethnicity groups (p for trend <0.05). Among all the race/ethnicity groups, non-Hispanic White people had the highest prevalence of reporting trouble sleeping to a healthcare provider.

CONCLUSION

Findings depict the persistence of sleep-related issues in the United States and possible risk factors, as well as racial disparities.

Individual and neighborhood socioeconomic status and long-term individual trajectories of sleep duration among Black and White adults: the Southern Community Cohort Study

STUDY OBJECTIVES

Sleep duration can change over the life course; however, previous studies rarely investigated the association between socioeconomic status (SES) and individual sleep trajectories over time. We examined the association between baseline socioeconomic characteristics and long-term sleep trajectories among Black and White adults.

METHODS

This study used data from the Southern Community Cohort Study (N = 45 035). Diverse trajectories of sleep duration were constructed using self-reported sleep duration at baseline and after ~10 years of follow-up. The associations between baseline socioeconomic characteristics and sleep trajectories were examined using multinomial logistic regression.

RESULTS

Both Black and White participants experienced similar long-term individual sleep trajectories for baseline educational attainment and employment status albeit the associations appeared stronger among White participants. Lower education and unemployment were associated with higher odds of various suboptimal sleep trajectories suggesting worsening long-term sleep patterns among both racial groups. However, there were some racial differences in the experience of long-term sleep trajectories for household income and neighborhood SES. Household income was notably more important among White than Black individuals; lower household income was associated with higher odds of more suboptimal long-term sleep trajectories for White than Black individuals. Also, neighborhood SES was slightly more important among White than Black individuals; lower neighborhood SES was associated with higher odds of a few suboptimal long-term sleep trajectories for both racial groups.

CONCLUSIONS

Lower socioeconomic characteristics were associated with various suboptimal long-term sleep trajectories among Black and White participants. Substantial improvements in socio-economic characteristics may contribute to improved sleep patterns.

Trends and disparities in sleep quality and duration in older adults in China from 2008 to 2018: A national observational study

Background

Poor sleep status as a common concern is a risk factor for many health problems among older people. China with an aging society lacks relevant nationwide data on the sleep status among older people. Therefore, the purpose of this study was to investigate trends and disparities in sleep quality and duration among older adults, and exploring influencing factors of poor sleep in China between 2008 and 2018.

Method

We used the four-waves data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Sleep quality and average sleep hours per day was investigated by using questionnaires in the CLHLS. We categorized sleep duration as three groups including ≤5 h (short duration), 5-9 h (normal duration), or ≥9 h (long duration) per day. Multivariate logistic regression models were used to examine trends and risk factors of poor sleep quality, short sleep duration, and long sleep duration.

Results

The prevalence of poor sleep quality significantly increased from 34.87% in 2008 to 47.67% in 2018 (p < 0.05). Short sleep duration significantly increased from 5.29 to 8.37%, whereas long sleep duration decreased from 28.77 to 19.27%. Multivariate analysis showed that female sex, poor economic status, a greater number of chronic diseases, underweight, poor self-reported quality of life, and poor self-reported health were associated with poor sleep quality and short sleep duration (p < 0.05).

Conclusion

Our findings revealed that older adults had increased prevalence of poor sleep quality and short sleep duration from 2008 to 2018. More attention should be paid to the increased sleep problems among older adults and early interventions should be made to improve sleep quality and guarantee enough sleep time.

Gender differences in the prevalence of and trends in sleep patterns and prescription medications for insomnia among US adults, 2005 to 2018

BACKGROUND

Evidence indicates that the burden of sleep disorders is increasing, yet recent trends have not been examined.

OBJECTIVE

To examine the prevalence of and trends in sleep patterns and medications commonly used for insomnia (MCUFI) in US adults from 2005 through 2018.

METHODS

A total of 39,749 participants aged 20 years or older from 7 consecutive National Health and Nutrition Examination Survey cycles during 2005-2018 were included.

RESULTS

The age-standardized prevalence of trouble sleeping and using MCUFI was higher in women than men, but men tended to sleep less (sleep duration <7 hours) and were more likely to have sleep disorders. The temporal trends in sleep disorders and MCUFI were similar in men and women, except that trouble sleeping increased more in men (P = 0.024). The prevalence of insufficient sleep decreased from 33.6% in women and 38.1% in men in 2005-2006 to 20.5% in women and 28.6% in men in 2017-2018. The prevalence of MCUFI use was 13.3% in women and 8.9% in men in 2005-2006, peaked at 15.2% for men and 17.0% for women in 2013-2014, and decreased slightly in 2015-2018.

CONCLUSION

The prevalence of trouble sleeping and MCUFI use was higher in women, while the prevalence of short sleep duration and sleep disorders was higher in men. Sleep disorders, abnormal sleep duration, and MCUFI use increased at a broadly similar pace in men and women, except that trouble sleeping increased more in men.

Sleep duration prior to an enterotoxigenic Escherichia coli challenge predicts diarrhea severity during infection

BACKGROUND

Acute diarrhea is the most frequent diagnosis among ill travelers. Sleep loss may weaken the body's defense against pathogens and increase susceptibility to infection. The relationship between sleep and infectious diarrhea has not been studied and was assessed utilizing data from a controlled human infection model (CHIM) for enterotoxigenic Escherichia coli (ETEC).

METHODS

During a CHIM assessing the efficacy of an immunoprophylactic targeting ETEC against moderate-to-severe diarrhea (MSD) following challenge, we measured sleep via actigraphy over an 8-day inpatient period. We hypothesized better sleep pre-challenge would predict illness symptomatology following challenge.

RESULTS

Among 57 participants (aged 34.4 ± 8.1 years, 64% male), there was no relationship between sleep metrics and incidence of MSD. However, longer total sleep time the night preceding ETEC challenge was associated with lower maximum 24 h diarrhea volume (B = -1.80, p = 0.01) and total diarrhea volume (B = -2.45, p = 0.01).

CONCLUSIONS

This novel study showed that shorter sleep duration predicted diarrhea severity over the course of an ETEC infection. Future work should experimentally manipulate sleep to further clarify its impact on diarrhea-related outcomes for ETEC and other important enteric pathogens.

Sleep-wake patterns and disturbances in Portuguese primary school children: a comparison between 1995 and 2016

Purpose

It is often assumed sleep duration has decreased and sleep schedules have delayed over the last decades, as society modernized. We aimed to investigate changes in the sleep patterns of school-age children over time.

Methods

We compared the sleep timings, durations, and disturbances of primary school-age children in 1995 and roughly two decades later, in 2016. Data from 666 children attending the 3rd and 4th grades of basic education were combined from two different cross-sectional school-based studies conducted within the same educational region of mainland Portugal using the same parent-report questionnaire (Children's Sleep-wake Patterns Questionnaire).

Results

Mean sleep duration did not differ significantly between the two time points (schooldays: t = .118, p = .906; free days: t = 1.310, p = .191), albeit the percentage of children sleeping the recommended number of hours decreased significantly in 2016 when compared to 1995 (schooldays: χ2 = 4.406, p = .036; free days: χ2 = 16.859, p < .001). Wake-times advanced on free days in 2016. Difficulties on settling to sleep alone and returning to sleep were more prevalent in 2016, as well as fearing the dark and needing lights on or parent's presence to fall asleep.

Conclusions

Sleep onset-related disturbances appear to have increased from 1995 to 2016. One possible explanation for this increase might be the change in parental practices preventing children from learning to fall asleep autonomously.

Sleep Deficiency: Epidemiology and Effects

Adequate sleep is an important pillar of physical and mental health. Sleep deficiency, resulting from short sleep or suboptimal sleep quality, is highly prevalent in modern society. Occupation, social demands, psychiatric disorders, physical disorders, and sleep disorders are some of the contributing factors to sleep deficiency. Some populations are at increased risk of sleep deficiency based on ethnicity, age, marital status, sex, and hospitalization. Sleep deficiency influences cognition, alertness, mood, behavior, diabetes, cardiovascular health, renal function, immune system, and respiratory physiology. This review summarizes the epidemiology and effects of sleep deficiency.

The association between sleep disorders on employment and income among adults in the United States

STUDY OBJECTIVES

To examine the association between sleep disorders, employment status, and income among US adults aged 18-64 years.

METHODS

The 2018-2019 Medical Expenditure Panel Survey medical conditions file was queried for adults aged 18-64 years with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) and linked to the household dataset. Comparisons in rates of wage, supplemental, and social security income as well as mean wage income were made between those with and without sleep disorders. Multivariate analyses, adjusting for demographics and comorbidities, were conducted.

RESULTS

A sleep disorder was diagnosed in 4.4% ± 0.2% of the study population (approximately 8.8 ± 0.4 million adults aged 18-64 years in the United States; mean age 46.9 years, 55.8% female). Adults with sleep disorders were less likely to have wage income from employment (adjusted odds ratio 0.5, 95% confidence interval 0.4-0.6, P < .001) and more likely to have Supplemental Security (1.8, 1.4-2.4, P < .001) and Social Security income (2.0, 1.6-2.4, P < .001) compared with those without sleep disorders. Among wage-earning adults, those with sleep disorders had $2,496 less mean annual wage income compared with those without a sleep disorder ($20,445 vs $22,941, P = .007), adjusting for demographics and comorbidities.

CONCLUSIONS

There are significantly higher indirect costs associated with sleep disorders. This study specifically demonstrates lower employment rates, lower wages, and higher welfare income utilization among those with sleep disorders despite using a very conservative estimate of sleep disorder prevalence.

CITATION

Huyett P, Bhattacharyya N. The association between sleep disorders, employment, and income among adults in the United States. J Clin Sleep Med. 2022;18(8):1967-1972.

Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018

Importance

Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years.

Objective

To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US.

Design, Setting, and Participants

This serial cross-sectional study used US population-based National Health Interview Survey data collected from 2004 to 2018. A total of 429 195 noninstitutionalized adults were included in the analysis, which was performed from July 26, 2021, to February 10, 2022.

Exposures

Self-reported race, ethnicity, household income, and sex.

Main Outcomes and Measures

Temporal trends and racial and ethnic differences in short (<7 hours in 24 hours) and long (>9 hours in 24 hours) sleep duration and racial and ethnic differences in the association between sleep duration and age.

Results

The study sample consisted of 429 195 individuals (median [IQR] age, 46 [31-60] years; 51.7% women), of whom 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White. In 2004, the adjusted estimated prevalence of short and long sleep duration were 31.4% and 2.5%, respectively, among Asian individuals; 35.3% and 6.4%, respectively, among Black individuals; 27.0% and 4.6%, respectively, among Hispanic or Latino individuals; and 27.8% and 3.5%, respectively, among White individuals. During the study period, there was a significant increase in short sleep prevalence among Black (6.39 [95% CI, 3.32-9.46] percentage points), Hispanic or Latino (6.61 [95% CI, 4.03-9.20] percentage points), and White (3.22 [95% CI, 2.06-4.38] percentage points) individuals (P < .001 for each), whereas prevalence of long sleep changed significantly only among Hispanic or Latino individuals (-1.42 [95% CI, -2.52 to -0.32] percentage points; P = .01). In 2018, compared with White individuals, short sleep prevalence among Black and Hispanic or Latino individuals was higher by 10.68 (95% CI, 8.12-13.24; P < .001) and 2.44 (95% CI, 0.23-4.65; P = .03) percentage points, respectively, and long sleep prevalence was higher only among Black individuals (1.44 [95% CI, 0.39-2.48] percentage points; P = .007). The short sleep disparities were greatest among women and among those with middle or high household income. In addition, across age groups, Black individuals had a higher short and long sleep duration prevalence compared with White individuals of the same age.

Conclusions and Relevance

The findings of this cross-sectional study suggest that from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals in the US. The disparities in short sleep duration appear to be highest among women, individuals who had middle or high income, and young or middle-aged adults, which may be associated with health disparities.

Sleep deficiency in spaceflight is associated with degraded neurobehavioral functions and elevated stress in astronauts on six-month missions aboard the International Space Station

Astronauts are required to maintain optimal neurobehavioral functioning despite chronic exposure to the stressors and challenges of spaceflight. Sleep of adequate quality and duration is fundamental to neurobehavioral functioning, however astronauts commonly experience short sleep durations in spaceflight (<6 h). As humans embark on long-duration space exploration missions, there is an outstanding need to identify the consequences of sleep deficiency in spaceflight on neurobehavioral functions. Therefore, we conducted a longitudinal study that examined the sleep-wake behaviors, neurobehavioral functions, and ratings of stress and workload of N = 24 astronauts before, during, and after 6-month missions aboard the International Space Station (ISS). The computerized, Reaction SelfTest (RST), gathered astronaut report of sleep-wake behaviors, stress, workload, and somatic behavioral states; the RST also objectively assessed vigilant attention (i.e. Psychomotor Vigilance Test-Brief). Data collection began 180 days before launch, continued every 4 days in-flight aboard the ISS, and up to 90 days post-landing, which produced N = 2,856 RSTs. Consistent with previous ISS studies, astronauts reported sleeping ~6.5 h in-flight. The adverse consequences of short sleep were observed across neurobehavioral functions, where sleep durations <6 h were associated with significant reductions in psychomotor response speed, elevated stress, and higher workload. Sleep durations <5 h were associated with elevated negative somatic behavioral states. Furthermore, longer sleep durations had beneficial effects on astronaut neurobehavioral functions. Taken together, our findings highlight the importance of sleep for the maintenance of neurobehavioral functioning and as with humans on Earth, astronauts would likely benefit from interventions that promote sleep duration and quality.

Acute Myocardial Infarction and Daylight Saving Time Transitions: Is There a Risk?

Available evidence on the risk of acute myocardial infarction (AMI) in the days after the spring daylight saving time (DST) transition suggests either a modest increase or no risk increase. Partial sleep deprivation and enhanced circadian clock misalignment have been implicated as the underlying mechanisms for increased AMI risk, probably via enhanced thrombo-inflammatory processes and activation of the sympathetic nervous system. Most of the studies, as we suggest as a perspective here, have used potentially inappropriate control periods, including the two post-transitional weeks, because adjustment after the spring DST transition lasts at least four weeks for all chronotypes and probably even beyond this period for late chronotypes. The most plausible conclusions, at the moment, for the risk of AMI after the spring DST transition are: (1) the risk is increased, (2) a relatively modest risk increase could be currently underestimated or in some studies undetected, (3) late chronotypes and/or individuals with high levels of social jetlag (a proxy for circadian clock misalignment) could be more affected by the phenomenon, and (4) underlying pathophysiological mechanisms should be further explored. As a significant part of world’s population continues to be affected by the biannual clock change, the question of increased AMI risk in the post-transitional period remains an intriguing public health issue.

The impact of social networks on sleep among a cohort of college students

Background

Sleep duration and quality are associated with physical and mental wellbeing. This paper examines social network effects on individual level change in the sleep quantity and quality from late adolescence to emerging adulthood and its associated factors, including the influence of peers on sleep behavior and the impact of changes in network size.

Methods

We use sleep data from 619 undergraduates at the University of Notre Dame obtained via Fitbit devices as part of the NetHealth project. The data were collected between August 16, 2015 and May 13, 2017. We model trends in sleep behaviors using latent growth-curve models.

Results

Controlling for the many factors known to impact sleep quantity and quality, we find two social network effects: increasing network size is associated with less sleep and a student's sleep levels are influenced by his or her peers. While we do not find any consistent decline in sleep quantity over the 637 days, daily fluctuations in sleep quantity are associated with changes in network size and the composition of a student's network. As a student's network gets bigger, s/he sleeps less, and when a student's contacts sleep more (or less) than s/he does, the student becomes more like his or her contacts and sleeps more (or less).

Conclusions

Social networks can and do impact sleep, especially sleep quantity. In contexts where students want to have larger networks, the difficulties of increasing network size and maintaining larger networks negatively impact sleep. Because of peer influence, the effectiveness of interventions designed to improve sleep practices could be increased by leveraging student social networks to help diffuse better sleep habits.

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The sleep habits of 619 undergraduates were traced with Fitbit devices for 637 days.

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Their sleep quantity measures were relatively stable but affect by peers.

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Their sleep quality was slightly getting worse but not affected by peers.

Incremental health care utilization and expenditures for sleep disorders in the United States

STUDY OBJECTIVES

To determine the incremental increases in health care utilization and expenditures associated with sleep disorders.

METHODS

Adults with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) within the medical conditions file of the 2018 Medical Expenditure Panel Survey medical conditions file were identified. This dataset was then linked to the consolidated expenditures file and comparisons in health care utilization and expenditures were made between those with and without sleep disorders. Multivariate analyses, adjusted for demographics and comorbidities, were conducted for these comparisons.

RESULTS

Overall, 5.6% ± 0.2% of the study population had been diagnosed with a sleep disorder, representing approximately 13.6 ± 0.6 million adults in the United States. Those with sleep disorders were more likely to be non-Hispanic, White, and female, with a higher proportion with public insurance and higher Charlson Comorbidity Scores. Adults with sleep disorders were found to have increased utilization of office visits (16.3 ± 0.8 vs 8.7 ± 0.3, P < .001), emergency room visits (0.52 ± 0.03 vs 0.37 ± 0.02, P < .001), and prescriptions (39.7 ± 1.2 vs 21.9 ± 0.4, P < .001) vs those without sleep disorders. The additional incremental health care expenses for those with sleep disorders were increased in all examined measures: total health care expense ($6,975 ± $800, P < .001), total office-based expenditures ($1,694 ± $277, P < .001), total prescription expenditures ($2,574 ± $364, P < .001), and total self-expenditures for prescriptions ($195 ± $32, P < .001).

CONCLUSIONS

Sleep disorders are associated with significantly higher rates of health care utilization and expenditures. By using the conservative prevalence estimate found in this study, the overall incremental health care costs of sleep disorders in the United States represents approximately $94.9 billion.

CITATION

Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-1986.

Sleep Duration and Waking Activities in Relation to the National Sleep Foundation's Recommendations: An Analysis of US Population Sleep Patterns from 2015 to 2017

The objective was to investigate the association between time spent on waking activities and nonaligned sleep duration in a representative sample of the US population. We analysed time use data from the American Time Use Survey (ATUS), 2015-2017 (N = 31,621). National Sleep Foundation (NSF) age-specific sleep recommendations were used to define recommended (aligned) sleep duration. The balanced, repeated, replicate variance estimation method was applied to the ATUS data to calculate weighted estimates. Less than half of the US population had a sleep duration that mapped onto the NSF recommendations, and alignment was higher on weekdays (45%) than at weekends (33%). The proportion sleeping longer than the recommended duration was higher than those sleeping shorter on both weekdays and weekends (p < 0.001). Time spent on work, personal care, socialising, travel, TV watching, education, and total screen time was associated with nonalignment to the sleep recommendations. In comparison to the appropriate recommended sleep group, those with a too-short sleep duration spent more time on work, travel, socialising, relaxing, and leisure. By contrast, those who slept too long spent relatively less time on each of these activities. The findings indicate that sleep duration among the US population does not map onto the NSF sleep recommendations, mostly because of a higher proportion of long sleepers compared to short sleepers. More time spent on work, travel, and socialising and relaxing activities is strongly associated with an increased risk of nonalignment to NSF sleep duration recommendations.

The return of sleep

While most individuals spend a substantial amount of time sleeping, Japan is among the developed countries whose residents register the fewest number of hours of sleep. I thus examine the causal effects of sleep on labor productivity, utilizing panel datasets for Japanese men. The potential endogeneity of deciding how many hours to sleep is addressed by using fixed effects panel data models with an instrumental variable estimation technique. Exploiting the annual variation in the average sunshine duration between cities as an instrument, I then show that a one-hour increase in the weekly number of hours of sleep increases the wage rate by up to 6-8% on average. These results suggest that sleep duration could enhance labor productivity.

Impact of COVID-19 social-distancing on sleep timing and duration during a university semester

Social-distancing directives to contain community transmission of the COVID-19 virus can be expected to affect sleep timing, duration or quality. Remote work or school may increase time available for sleep, with benefits for immune function and mental health, particularly in those individuals who obtain less sleep than age-adjusted recommendations. Young adults are thought to regularly carry significant sleep debt related in part to misalignment between endogenous circadian clock time and social time. We examined the impact of social-distancing measures on sleep in young adults by comparing sleep self-studies submitted by students enrolled in a university course during the 2020 summer session (entirely remote instruction, N = 80) with self-studies submitted by students enrolled in the same course during previous summer semesters (on-campus instruction, N = 452; cross-sectional study design). Self-studies included 2–8 week sleep diaries, two chronotype questionnaires, written reports, and sleep tracker (Fitbit) data from a subsample. Students in the 2020 remote instruction semester slept later, less efficiently, less at night and more in the day, but did not sleep more overall despite online, asynchronous classes and ~44% fewer work days compared to students in previous summers. Subjectively, the net impact on sleep was judged as positive or negative in equal numbers of students, with students identifying as evening types significantly more likely to report a positive impact, and morning types a negative impact. Several features of the data suggest that the average amount of sleep reported by students in this summer course, historically and during the 2020 remote school semester, represents a homeostatic balance, rather than a chronic deficit. Regardless of the interpretation, the results provide additional evidence that social-distancing measures affect sleep in heterogeneous ways.

Sleep and high-risk behavior in military service members: a mega-analysis of four diverse U.S. Army units

Experimental sleep restriction and deprivation lead to risky decision-making. Further, in naturalistic settings, short sleep duration and poor sleep quality have been linked to real-world high-risk behaviors (HRB), such as reckless driving or substance use. Military populations, in general, tend to sleep less and have poorer sleep quality than nonmilitary populations due to a number of occupational, cultural, and psychosocial factors (e.g. continuous operations, stress, and trauma). Consequently, it is possible that insufficient sleep in this population is linked to HRB. To investigate this question, we combined data from four diverse United States Army samples and conducted a mega-analysis by aggregating raw, individual-level data (n = 2,296, age 24.7 ± 5.3). A negative binomial regression and a logistic regression were used to determine whether subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], and duration [h]) predicted instances of military-specific HRB and the commission of any HRB (yes/no), respectively. Poor sleep quality slightly elevated the risk for committing HRBs (PSQI Exp(B): 1.12 and ISI Exp(B): 1.07), and longer duration reduced the risk for HRBs to a greater extent (Exp(B): 0.78), even when controlling for a number of relevant demographic factors. Longer sleep duration also predicted a decreased risk for commission of any HRB behaviors (Exp(B): 0.71). These findings demonstrate that sleep quality and duration (the latter factor, in particular) could be targets for reducing excessive HRB in military populations. These findings could therefore lead to unit-wide or military-wide policy changes regarding sleep and HRB.

Sleep behavior is associated with over two-fold decrease of sperm count in a chronotype-specific pattern: path analysis of 667 young men in the MARHCS study

Recent studies have shown that the reduction of sperm count is associated with sleep behaviors, including restricted/excessive sleep duration, late sleep time midpoint, and shift of sleep midpoint time (social jetlag). Chronotype is suggested to regulate sleep behaviors; however, the relationship between chronotype and human sperm count is unknown. The relationship between sleep behaviors and human sperm count, when sleep behaviors as well as chronotype are controlled is also unclear. We performed a path analysis of the data obtained from 667 Chinese men recruited into the MARHCS (Male Reproductive Health in Chongqing College Students) study. Chronotype, sleep duration, sleep time midpoint, and social jetlag were estimated by the Munich Chronotype Questionnaire. Sperm count was measured by computer-aided sperm analysis. The comprehensive relationship between chronotype, all sleep behaviors, and sperm count was tested by path analysis, in which the standardized residual of sperm count was used for adjustment of age, abstinence period, body mass index, tobacco smoking, alcohol drinking, and intake of tea, cola, and coffee. Our major findings are: (1) Chronotype negatively correlated with sleep duration (correlation coefficient (R) = -0.32, P < .001) and positively correlated with sleep midpoint (R = 0.65, P < .001) and social jetlag (R = 0.37, P < .001). (2) Sleep duration (U-shape transformed; R = -0.11, P = .005), sleep midpoint (R = -0.09, P = .021), and social jetlag (R = -0.12, P = .001), respectively, correlated with sperm count in univariate analysis. The relationship between sleep midpoint and sperm count disappeared when social jetlag was controlled. (3) Path analysis showed that chronotype is connected with sperm count through two pathways: via sleep duration (standardized path coefficient = -0.09, 95% CI: -0.17 to -0.01, P = .030) and via social jetlag (standardized path coefficient = -0.09, 95% CI: -0.17 to -0.01, P = .031). For men of earlier, intermediate, and later tertile of chronotype, the sleep-duration-related decrease of sperm count was separately estimated to be 16.3%, 12.8%, and 11.6%, while the social-jetlag-related decrease of sperm count was estimated to be 9.3%, 12.8%, and 19.2%. The total effect of sleep behaviors on sperm count was estimated to be 25.7%, 25.6%, and 30.7%, with an average of 27.4% for men of different chronotypes. The present study showed that men of earlier chronotype were prone to restricted/excessive sleep duration, while men of later chronotype were prone to social jetlag, both of which correlated with reduced sperm count, suggesting that chronotype may modulate the sleep behaviors and exert dual effects on sperm count via different sleep behaviors, leading to a ubiquitous sperm decline. Men of different chronotypes should take care to avoid different types of improper sleep behaviors, so as to prevent such deleterious effect on sperm count.

Effects of six weeks of chronic sleep restriction with weekend recovery on cognitive performance and wellbeing in high-performing adults

Chronic sleep loss is associated with escalating declines in vigilant attention across days of sleep restriction. However, studies exceeding two weeks of chronic sleep loss are scarce, and the cognitive performance outcomes assessed are limited. We assessed the effects of six weeks of chronic sleep restriction on a range of cognitive domains in 15 high-performing individuals (38.5±8.2 years, 6 women) confined to small space in groups of four. Sleep opportunities were limited to 5h on weekdays and 8h on weekends. Individual sleep/wake patterns were recorded with actigraphy. Neurobehavioral performance was assessed in evenings with Cognition, a computerized battery of ten tests assessing a range of cognitive domains. There were some small to moderate effects of increasing sleep debt relative to pre-mission baseline, with decreases in accuracy across cognitive domains (standardized β=0.121, p=0.001), specifically on tests of spatial orientation (β=0.289, p=0.011) and vigilant attention (β=0.688, p<0.001), which were not restored by two nights of weekend recovery sleep. Cognitive and subjective decrements occurred despite occasional daytime napping in breach of study protocol, evening testing around the circadian peak, and access to caffeine before 14:00. Sensorimotor speed, spatial learning and memory, working memory, abstraction and mental flexibility, emotion identification, abstract reasoning, cognitive throughput and risk decision making were not significantly affected by sleep debt. Taken together with modest lower subjective ratings of happiness and healthiness, these findings underline the importance of sufficient sleep, on both an acute and chronic basis, for performance in selected cognitive domains and subjective wellbeing in operationally-relevant environments.

Opposite educational gradients in sleep duration between Black and White adults, 2004-2018

OBJECTIVES

To investigate the heterogeneous effects of education on sleep duration for Black and White adults and how the education effects changed between 2004 and 2018.

METHODS

A total of 251,994 adult participants in the 2004 to 2018 National Health Interview Survey were included in pooled cross-sectional data analyses. Separately for Black and White men and women, we calculated prevalence ratio and average marginal probability of short sleep (<7 hours) for each education level over the study period based on weighted logistic regression models.

RESULTS

Opposite educational gradients in short sleep were observed between Black and White adults. Greater educational attainment was associated with lower likelihood of short sleep among White adults but higher likelihood of short sleep among Black adults. Such heterogeneous educational gradients were robust after accounting for a set of socioeconomic, family, and health factors and persisted between 2004 and 2018.

CONCLUSIONS

The health implications of education are not uniform in the US population, and heterogeneous education effects on sleep duration persisted over the past decade. More scholarly attention is needed to identify challenges and barriers that may be unique for race, sex, and education subpopulations to maintain healthy sleep.

Association between e-cigarette use and sleep deprivation in U.S. Young adults: Results from the 2017 and 2018 Behavioral Risk Factor Surveillance System

BACKGROUND

Few studies have assessed the association between e-cigarette use and sleep deprivation. This is an important question given the rapid increase in e-cigarette use among young adults in recent years.

PURPOSE

To determine whether e-cigarette use is associated with sleep deprivation in a sample of young (18-24 years-old) American adults.

METHODS

We used pooled cross-sectional data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS), selecting respondents aged 18 to 24 from forty-one states and U.S. territories that included the e-cigarette and sleep modules in the interview (N = 19,701). Poisson regression models tested the relationship between e-cigarette use and sleep deprivation. We adjusted for sociodemographic variables, physical activity, mental health, BMI, smokeless tobacco products use, alcohol drinking, and smoking.

RESULTS

In the pooled dataset, the weighted prevalence of current or former e-cigarette use was 47% and 35% of participants self-reported sleep deprivation. After adjusting for confounders, former e-cigarette users were 1.17 times more likely to report sleep deprivation, compared to never users (95%CI: 1.06, 1.29). The prevalence ratio for self-reported sleep deprivation increased to 1.42 (95%CI: 1.23, 1.65) for everyday users, compared to never e-cigarette users.

CONCLUSIONS

These findings suggest that e-cigarette use might be related to sleep deprivation in young adults. Future longitudinal studies should assess the causal and dose-response nature of this relationship.

Associations of short sleep duration with appetite-regulating hormones and adipokines: A systematic review and meta-analysis

In the current study, a systematic review and meta-analysis were conducted to summarize and assess whether short sleep duration is associated with appetite-regulating hormones and adipokine levels. Reference databases were searched for studies related to sleep and appetite-regulating hormones and adipokines. Qualitative and quantitative syntheses were conducted to evaluate the relationship between sleep duration and the level of appetite-regulating hormones and adipokines, including leptin, ghrelin, adiponectin, resistin, and orexin. Twenty-one of 3536 studies, covering a total of 2250 participants, met the inclusion criteria. Leptin, ghrelin, and adiponectin were included in the meta-analysis. Ghrelin levels were higher in the short sleep group (standard mean difference [SMD] = 0.14, 95% CI [0.03, 0.25], p = 0.01). Significant differences between the short sleep group and recommended sleep group were also noted in leptin level experimental subgroup studies (SMD = 0.19, 95% CI [0.03, 0.35], p = 0.02) and ghrelin level cross-sectional subgroup studies (SMD = 0.14, 95% CI [0.02, 0.27], p = 0.03). A rise in leptin and ghrelin levels were also observed in sleep deprivation groups (SMD = 0.24, 95% CI [0.10, 0.39], p = 0.001 and SMD = 0.18, 95% CI [0.04, 0.33], p = 0.01, respectively). In conclusion, short sleep duration is associated with an increased ghrelin level, while sleep deprivation had a significant effect on the levels of both leptin and ghrelin.

Changes in self-reported sleep duration with age - a 36-year longitudinal study of Finnish adults

BACKGROUND

Sleep deprivation is often claimed to be increasingly common, but most studies show small changes in sleep duration over the last decades. Our aim was to analyze long-term patterns in self-reported sleep duration in a population-based cohort.

METHODS

Members of the Older Finnish Twin Cohort have responded to questionnaires in 1975 (N = 30,915 individuals, response rate 89%, mean age 36 years), 1981 (24,535, 84%, 41 years), 1990 (12,450, 77%, 44 years), and 2011 (8334, 72%, 60 years). Weibull regression models were used to model the effects of follow-up time and age simultaneously.

RESULTS

Sleep duration has decreased in all adult age groups and in both genders. The mean duration was in men 7.57 h in 1975 and 7.39 in 2011, and in women 7.69 and 7.37, respectively. The decrease was about 0.5 min in men and 0.9 in women per year of follow-up. In the age-group 18-34 years, mean sleep length was 7.69 h in 1975 and 7.53 in 1990. Among 35-54-year-old it was 7.57 h in 1975 and 7.34 in 2011, and in the age group of 55+ year olds 7.52 and 7.38, correspondingly. The change was largest in middle-aged group: about 23 min or about 0.6 min per year of follow-up.

CONCLUSIONS

There has been a slight decrease in mean sleep duration during the 36-year follow-up. Although the sleep duration was longer in 1970s and 1980s, the probable main cause for the change in this study population is the effect of aging.

Brain mechanisms of insomnia: new perspectives on causes and consequences

While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.

Effectiveness of incentives and follow-up on increasing survey response rates and participation in field studies

Background

Questionnaires are valuable data collection instruments in public health research, and can serve to pre-screen respondents for suitability in future studies. Survey non-response leads to reduced effective sample sizes and can decrease representativeness of the study population, so high response rates are needed to minimize the risk of bias. Here we present results on the success of different postal questionnaire strategies at effecting response, and the effectiveness of these strategies at recruiting participants for a field study on the effects of aircraft noise on sleep.

Methods

In total, we mailed 17 rounds of 240 questionnaires (total n = 4080) to randomly selected households around Atlanta International Airport. Different mailing rounds were varied in the length of the questionnaire (11, 26 or 55 questions), survey incentive (gift card or $2 cash), number of follow-up waves (0, 2 or 3), incentive for participating in a 5-night in-home sleep study ($100, $150 or $200), and address personalization.

Results

We received completed questionnaires from 407 respondents (response rate 11.4%). Personalizing the address, enclosing a $2 cash incentive with the initial questionnaire mailing and repeated follow-up mailings were effective at increasing response rate. Despite the increased expense of these approaches in terms of each household mailed, the higher response rates meant that they were more cost-effective overall for obtaining an equivalent number of responses. Interest in participating in the field study decreased with age, but was unaffected by the mailing strategies or cash incentives for field study participation. The likelihood that a respondent would participate in the field study was unaffected by survey incentive, survey length, number of follow-up waves, field study incentive, age or sex.

Conclusions

Pre-issued cash incentives and sending follow-up waves could maximize the representativeness and numbers of people from which to recruit, and may be an effective strategy for improving recruitment into field studies.

Sleep timing and duration in indigenous villages with and without electric lighting on Tanna Island, Vanuatu

It has been hypothesized that sleep in the industrialized world is in chronic deficit, due in part to evening light exposure, which delays sleep onset and truncates sleep depending on morning work or school schedules. If so, societies without electricity may sleep longer. However, recent studies of hunter-gatherers and pastoralists living traditional lifestyles without electricity report short sleep compared to industrialized population norms. To further explore the impact of lifestyles and electrification on sleep, we measured sleep by actigraphy in indigenous Melanesians on Tanna Island, Vanuatu, who live traditional subsistence horticultural lifestyles, in villages either with or without access to electricity. Sleep duration was long and efficiency low in both groups, compared to averages from actigraphy studies of industrialized populations. In villages with electricity, light exposure after sunset was increased, sleep onset was delayed, and nocturnal sleep duration was reduced. These effects were driven primarily by breastfeeding mothers living with electric lighting. Relatively long sleep on Tanna may reflect advantages of an environment in which food access is reliable, climate benign, and predators and significant social conflict absent. Despite exposure to outdoor light throughout the day, an effect of artificial evening light was nonetheless detectable on sleep timing and duration.

Sleep Restriction, Sleep Hygiene, and Driving Safety: The Importance of Situational Sleepiness

Sleep-related accidents are a frequent cause of death and injury in the world. Poor sleep hygiene is responsible for sleep deprivation, which is clearly associated with an increased risk of accidents. Evidence shows that self-reported sleepiness at the wheel and reporting of inappropriate line-crossings are strong predictors of accident risk. Although the Epworth sleepiness scale is widely used in clinical practice, it is not the best to evaluate driving risks. Simple questions on the occurrence of near misses and sleepiness at the wheel should be asked systematically to address the issue of fitness to drive.

Acute sleep deprivation and culpable motor vehicle crash involvement

Study Objectives

To quantify the relationship between acute sleep deprivation and culpable involvement in motor vehicle crashes.

Methods

Participants were 6845 drivers involved in a representative sample of crashes investigated by the US Department of Transportation in years 2005-2007. A modified case-control study design was used to compare self-reported hours of sleep in the 24 hr before crashing between drivers deemed culpable versus nonculpable. Analyses controlled for fatigue-related, driver-related, and environmental factors. Specific errors that led to crashes were also examined.

Results

Drivers who reported having slept for 6, 5, 4, and less than 4 hr in the 24 hr before crashing had 1.3 (95% confidence interval [CI] = 1.04 to 1.7), 1.9 (1.1 to 3.2), 2.9 (1.4 to 6.2), and 15.1 (4.2 to 54.4) times the odds, respectively, of having been culpable for their crashes, compared with drivers who reported 7-9 hr of sleep. Drivers who had slept less than 4 hr had 3.4 (95% CI = 2.1 to 5.6) times the increase in odds of culpable involvement in single-vehicle crashes compared with multiple-vehicle crashes. Recent change in sleep schedule, typically feeling drowsy upon waking, and driving for 3+ hr were also associated with culpability (all p ≤ 0.013). Assuming nonculpable drivers comprised a representative sample of all drivers present where crashes occurred, these odds ratios approximate incidence rate ratios for culpable crash involvement per unit of time driving.

Conclusions

Driving after having slept less than 7 hr in a 24 hr period is associated with elevated risk of culpable crash involvement. Risk is greatest for drivers who have slept less than 4 hr and is manifested disproportionately in single-vehicle crashes.

Are U.S. adults reporting less sleep?: Findings from sleep duration trends in the National Health Interview Survey, 2004-2017

Study Objectives

To document trends in self-reported sleep duration for the noninstitutionalized U.S. civilian population from 2004 to 2017 and examine how sleep trends vary by race/ethnicity.

Methods

We use data from the National Health Interview Survey (NHIS) for U.S. noninstitutionalized adults aged 18-84 from 2004 to 2017 (N = 398 382). NHIS respondents were asked how much they slept in a 24-hour period on average, which we categorized as ≤6 hr (short sleep), 7-8 hr (adequate sleep), and ≥9 hr (long sleep). We used multinomial logistic regression models to examine trends in self-reported sleep duration and assess race/ethnic differences in these trends. Our models statistically adjusted for demographic, socioeconomic, familial, behavioral, and health covariates.

Results

The prevalence of short sleep duration was relatively stable from 2004 to 2012. However, results from multinomial logistic regression models indicated that there was an increasing trend toward short sleep beginning in 2013 (b: 0.09, 95% CI: 0.05-0.14) that continued through 2017 (b: 0.18, 95% CI: 0.13-0.23). This trend was significantly more pronounced among Hispanics and non-Hispanic blacks, which resulted in widening racial/ethnic differences in reports of short sleep.

Conclusions

Recent increases in reports of short sleep are concerning as short sleep has been linked with a number of adverse health outcomes in the population. Moreover, growing race/ethnic disparities in short sleep may have consequences for racial and ethnic health disparities.

Sleep and obesity: the mediating role of health behaviors among African Americans

OBJECTIVES

To examine the role of health behaviors (eg, physical activity, sedentary behaviors, and diet) in the relationship between sleep (ie, duration and quality) and BMI among African American adults.

DESIGN

A cross-sectional self-report questionnaire included questions related to health and health-related behaviors.

SETTING

This study was based on data from the CHURCH study, which aimed to address cancer health disparities among church-going African Americans in Houston, TX.

PARTICIPANTS

African American adults were recruited from three large community churches. The sample included a total of 1837 participants (75.2% female; mean age 48.2 ± 13.7y; mean BMI 32.0 ± 7.5 kg/m²).

MEASUREMENTS

Linear regression models and path analyses controlling for demographic characteristics and depression estimated the associations between sleep and BMI as well as the mediating roles of health behaviors.

RESULTS

The average self-reported sleep duration was 6.2 ± 1.5 h/night with 61%, 35.8%, and 1.6% reporting short (≤6 h/night), normal (7-9 h/night), and long sleep (≥10 h/night), respectively. Short sleep was related to greater BMI (b = 1.37, SE = 0.38, P = .01), and the relationship was mediated by sedentary behaviors (est. = 0.08, SE = 0.04, 95% CI: 0.02, 0.17).

CONCLUSIONS

Short sleep and poor quality sleep was related to poor diet and physical activity-related health behaviors, and BMI. The link between sleep and obesity is, in part, due to energy imbalance from increased sedentary behavior.

The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research

New sleep deprivation studies confirm the relationship between inadequate sleep and a wide range of disorders, such as hypertension, obesity and type-2 diabetes, cardiovascular disease, impaired immune functioning, and more.

Prevalence of childhood obstructive sleep apnea syndrome and its role in daytime sleepiness

Objectives

To investigate childhood obstructive sleep apnea syndrome (OSAS) and its role in daytime sleepiness among school-age children.

Methods

A questionnaire survey was conducted with 25,211 children aged 6–15 (mean, 10.39) years attending 148 elementary and 71 middle schools in 10 prefectures across Japan and their parents. Questions concerned 4 sleep habit items (bedtime, sleep onset latency, wake time after sleep onset, wake-up time) and 4 sleep disorder items (loud snoring, snorts/gasps, breathing pauses, seems very sleepy in the daytime). Total sleep time (TST) was calculated with sleep habits. Severe possible OSAS (p-OSAS) was defined as having loud snoring, snorts and gasps, or breathing pauses “frequently” (≥ 5 times per week), and mild p-OSAS was rated as having any of these “sometimes” (2–4 times per week). Severe daytime sleepiness was defined as seeming very sleepy “frequently” and mild daytime sleepiness as seeming very sleepy “sometimes”.

Results

Mean prevalence of mild to severe p-OSAS and severe p-OSAS in children across all grade levels was 9.5% and 1.6%, respectively. p-OSAS was particularly prevalent in children at lower elementary levels, decreasing with advancing grade levels. Prevalence of mild and severe daytime sleepiness was 6.1% and 0.9%, respectively, among all children (7.0%). Prevalence of daytime sleepiness increased with advancing grade levels, particularly in middle-school level. Average TST was 8.4 ± 2.2 h in both elementary and middle-school levels, and decreased as grades advanced, particularly in middle-school levels. Multivariate logistic regression analysis showed that middle-school level, TST < 8 h, and p-OSAS were independent factors for daytime sleepiness. Strong correlations were found between severe daytime sleepiness and severe p-OSAS or TST < 6 h, and between daytime sleepiness and loud snoring or breathing pauses.

Conclusion

p-OSAS may be an independent factor influencing daytime sleepiness in school-age children. Loud snoring and breathing pauses could be clinical markers for children with severe daytime sleepiness.

Disparities in sleep duration and restedness among same- and different-sex couples: findings from the American Time Use Survey

Study Objectives

The importance of sleep for health necessitates investigation of disparities in multiple aspects of sleep. Given the potential disruption to sleep posed by the well-documented discrimination experienced by sexual minorities, disparities related to sexual minority status warrant such attention. This study sought to (1) measure differences in same- and different-sex couples in sleep duration and perceived restedness, (2) examine how the link between sleep duration and restedness varied among same- and different-sex couples, and (3) assess variation in restedness across state-level sexual minority indicators.

Methods

Participants in the Wellbeing Module of the American Time Use Survey, assessed in 2010, 2012, and 2013 (n = 17378), completed time diaries assessing sleep duration and evaluated their own restedness.

Results

Multinomial and ordinal regression analyses showed no links between partner sex and sleep among men. Women with same-sex partners reported lower restedness than women with different-sex partners, and perceptions of restedness were more strongly linked to sleep duration for the former than the latter. Finally, women with the same-sex partners living in states more supportive of sexual minorities reported better restedness than those in less supportive states.

Conclusions

Women with same-sex partners were vulnerable to lower restedness, especially when they reported lower sleep duration or were in less supportive environments. Such disparities could underlie related disparities in health, as sleep health is predictive of health outcomes. Future research is needed to explore the role of sleep in explaining variation in health outcomes among sexual minority women.